In a highly anticipated decision, the court ruled by a 5-4 majority that the health care law is constitutional. It upheld key provisions of the law, including a mandate for most people to have health insurance starting in 2014 or pay a penalty.
The overhaul will expand coverage to millions of uninsured people in two years by expanding Medicaid and providing tax credits to help middle-income people who don't get insurance through their jobs to buy it on their own. The law's penalty also is expected to prod people to buy coverage.
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These changes could bring millions of new customers to a managed-care sector that has had a hard time finding steady growth opportunities in the slow economy. But the law also restricts the sector and imposes annual fees that start in 2014 at $8 billion and climb in subsequent years.
The law limits how much insurers can vary prices based on customers' age or health, and it requires insurers to pay rebates if they don't spend a minimum percentage of the premiums they collect on improvements in care and quality.
Investors in managed-care companies wanted the law overturned, but Goldman Sachs analyst Matthew Borsch said in a research note that they're not likely to abandon those stocks because many anticipated the court would uphold the law, even before hearing the justices' questions about it during oral arguments in March.
Borsch said the news is positive for insurers — such as WellCare Group Inc. of Tampa, Fla., and St. Louis-based Centene Corp. — that specialize in Medicaid coverage.
In contrast, the ruling increases pressure on insurers that rely more heavily on providing plans for individuals and small businesses — such as WellPoint Inc., the Indianapolis-based Blue Cross Blue Shield provider and the second largest health insurer in the country.
"The bad news, for some players, is that the small-group and individual market will remain a tough sandbox to play in," BMO Capital analyst Dave Shove wrote in a separate note.
Fitch Ratings said Thursday that the ruling doesn't change its opinions on health insurers because its effects are "minimal" over the next year or two and less clear over the longer term.
Here's how health insurers' shares were faring by late Thursday afternoon:
— WellPoint shares lost $3.45, or 5 percent, to $66.04;
— UnitedHealth Group Inc. stock was down 13 cents, to $59.16;
— Aetna Inc. shares declined $1.23, or 3 percent, to $39.73.
Shares of insurers that handle a lot of Medicaid business were doing better.
— WellCare jumped $3.76, or 8 percent, to $53.37; and
— Centene rose 60 cents, or 2 percent to $30.51.
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